Recent studies suggest a direct relationship between free testosterone and cavernous vasodilatation. Some men with erectile dysfunction (ED) associated with PADAM (partial androgen deficiency in aging men) might possibly benefit from testosterone undecanoate therapy (TRT).
To determine the efficacy of testosterone undecanoate in facilitating the erectile response and patient satisfaction with sildenafil in men 40-70 years old with PADAM symptoms.
Prospective study including 40 patients recruited after a sildenafil therapeutic trial. Total testosterone and sex hormone binding globulin (SHBG) were measured to calculate the free androgen index. Prostate specific antigen (PSA) was measured and repeated 2 months after treatment. A rating score was used for PADAM symptoms, and the 5-point abbreviated version of the International Index of Erectile Function (IIEF-5) to assess erectile function. Men failing to respond to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT (group 1ST), and TRT (group 1T) alone. Men partially responding to sildenafil were randomized into two groups receiving sildenafil plus continuous TRT for 2 months (group 2ST), or sildenafil alone (group 2S). Treatment efficacy was assessed by analysis of between-group differences.
Groups 1T, 2S, and 2ST showed significant improvement in PADAM scores (P<0.05, Wilcoxon matched pairs test). Patients receiving both sildenafil plus continuous TRT (groups 1ST and 2ST) showed significant improvement in IIEF-5 scores (P<0.5, paired t-test). No significant changes in serum levels of PSA were detected (paired t-test).
We conclude that TRT appears to be beneficial and safe in facilitating the erectile response and patient satisfaction with sildenafil in men with PADAM symptoms. Androgen supplementation should be carried out cautiously with careful monitoring to avoid possible adverse effects.
"These include patients with hypogonadism or hyperprolactinemia who need specific hormonal treatment to improve erectile function (EF). In animals, the pharmacological activity of PDE5 inhibitors appears to be androgen-dependent;1,9 indeed the expression of PDE5 in humans also appears to be androgen-dependent.1 Testosterone deficiency seems to predict a poor response to sildenafil10-12 or tadalafil13 and the addition of testosterone seemed helpful in five uncontrolled studies.12-14 In addition, some patients with Peyronie's disease need treatment for penile curvature or pain during intercourse and other patients do not have ED, but they experience ejaculatory dysfunction or sensory disturbances. "
[Show abstract][Hide abstract] ABSTRACT: Currently, phosphodiesterase type 5 (PDE5) inhibitors are the initial treatment option for erectile dysfunction. The reported efficacy of PDE5 inhibitors is about 70%, although it is significantly lower in difficult-to-treat subpopulations. Treatment failures might be due to the severity of the underlying pathophysiology, improper use of medication, unrealistic patient expectations, difficult relationship dynamics, severe performance anxiety, and other psychological problems. Physicians must address these issues to identify true treatment failures attributable to the drugs. This article discusses factors that might affect the response to PDE5 inhibitors and develops a strategy to maximize the overall efficacy of PDE5 inhibitors in initial non-responders to PDE5 inhibitors.
[Show abstract][Hide abstract] ABSTRACT: Although testosterone therapy is enough to restore normal erectile function in the rare young man who presents with severe
testosterone deficiency (TD), it often fails when administered alone in middle-aged and older men with low serum testosterone
discovered following a consultation for erectile dysfunction (ED). Comorbidities, especially penile vascular damage, are associated
with TD in most ED cases and prevent testosterone therapy from improving erections. Conversely, phosphodiesterase type V inhibitor
(PDE5I) therapy alone cannot improve reduced sexual desire, which is often associated with ED in the case of TD. Therefore,
there is often an indication for combination therapy with PDE5I and testosterone in men with ED who are older than age 50.
A minimum serum testosterone level may also be required to achieve the full efficacy of PDE5Is. This was demonstrated in laboratory
animals but has not yet been fully confirmed in men.
Current Sexual Health Reports 09/2008; 5(3):135-140. DOI:10.1007/s11930-008-0024-7
[Show abstract][Hide abstract] ABSTRACT: Descripción: El American College of Physicians desarrolló estas guías clínicas para presentar la evidencia disponible sobre la evaluación hormonal y el tratamiento farmacológico de la disfunción eréctil. Las terapéutica farmacológica actual incluye a los inhibidores de la 5-fosfodiesterasa (PDE-5) como el sildenafil, vardenafil, tadalafil, mirodenafil y udenafil, así como el tratamiento hormonal. Métodos: La literatura publicada sobre este tema fue identificada usando MEDLINE (1966 a mayo del 2007), EMBASE (1980 a la semana 22 del 2007), el Registro Central de Estudios Controlados Cochrane (segunda trimestre del 2007), PsycINFO (1985 a junio del 2007), AMED (1985 a junio del 2007), y SCOPUS (2006). La búsqueda bibligráfica fue actualizada buscando artículos en MEDLINE y EMBASE publicados entre mayo 2007 y abril 2009. Las búsquedas se limitaron a publicaciones en idioma inglés. Esta guía clínica establece el nivel de evidencia y el grado de recomendación utilizando el sistema de graduación de las guías clínicas del American College of Physicians.
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